Articles: mortality.
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Comparative Study
Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States.
To compare the disease-specific mortality rates of the indigenous populations of New Zealand, Australia, Canada, and the United States with the non-indigenous populations in each country. ⋯ Australia experienced the largest relative and absolute disparities in life expectancy between indigenous and non-indigenous populations. For specific causes of death, New Zealand Maori, and Australian Aboriginals and Torres Strait Islanders experienced the highest levels of disparities when compared to their respective non-indigenous population group. Large disparities exist for indigenous peoples in all four countries for diabetes mortality. CONCLUSION The indigenous peoples of New Zealand and Australia suffer from high disease-specific mortality rates. The relative size of indigenous/non-indigenous mortality disparities are highest in New Zealand and Australia. There appears to be a number of common issues that adversely affect the quality of the mortality data that is available in the four countries. Action is required to address indigenous health disparities and to improve the quality of indigenous mortality data.
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Survival from acute coronary syndromes and major trauma has been shown to depend on timely access to definitive treatment. We sought to identify the significance of intensive care unit (ICU) admission delay (lead-time) on the outcome of critically-ill medical patients with other diagnoses. ⋯ ICU admission delay (lead-time) is associated with a greater mortality-risk in critically ill medical patients requiring MV and/or RRT.
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Sedative drugs are used routinely in critically ill patients to reduce both physical and psychological stresses imposed by the hostile intensive care unit environment. However, drug accumulation, particularly during prolonged administration, often poses difficulties. Sedation scales chart the physiological effect of sedation although many surveys have revealed that few units use them to monitor the effect of sedative agents hence oversedation is common. ⋯ Our study demonstrates that the use of a sedation scale lead to a decrease in sedative, analgesic and inotrope use with a trend to less ventilated hours in critically ill patients.
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Cardiogenic shock has long been a difficult problem for clinicians. The most common cause is left ventricular pump failure after myocardial infarction, but other important causes include mechanical complications of infarction, right ventricular dysfunction, prolonged cardiopulmonary bypass, valvular disease, and cardiomyopathy. Cardiogenic shock is the leading cause of in-hospital death after myocardial infarction. ⋯ Improved understanding of the pathophysiology of cardiogenic shock has led to renewed emphasis on the notion that stunned or hibernating myocardium may recover function with hemodynamic support and restoration of flow. This concept has underscored the importance of expeditious initiation of supportive measures to maintain blood pressure and cardiac output, including both medications and intraaortic balloon counterpulsation. Finally, the theory that coronary revascularization would be beneficial by reversing the vicious cycle in which ischemia causes myocardial dysfunction, which in turn worsens ischemia, which had been supported by an extensive body of observational and registry studies, has now been strongly buttressed by the results of two randomized, controlled trials, both of which show improved mortality with early revascularization for cardiogenic shock in the setting of acute infarction.